Provider Demographics
NPI:1346331006
Name:SPERRE, BRIAN CHESTER (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHESTER
Last Name:SPERRE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-7153
Mailing Address - Country:US
Mailing Address - Phone:508-586-3613
Mailing Address - Fax:508-586-3613
Practice Address - Street 1:1351 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7153
Practice Address - Country:US
Practice Address - Phone:508-586-3613
Practice Address - Fax:508-586-3613
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1509213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0334391Medicaid
MA0334391Medicaid
MAY70621Medicare ID - Type Unspecified